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I usually start with Adrian Louw’s alarm analogy. For patient’s that need more, I will give the example of the construction worker with the nail through his boot wailing in pain, but come to find out the nail went in between his toes. I think that example can really illustrate how pain is an OUTPUT of the system, and not a specific input.
This usually opens the door to talking about how many complex things can modulate that output like sleep, depression, fear, etc.
I think that’s a great place to start with people, and then it has to get more individualized.
I have a difficult patient right now that has chronic LBP s/p surgery ~1 year ago. He is really having trouble understanding why he is still hurting after the surgery. His daughter got married in September and he danced with her at the wedding basically pain free, and his pain started up again the next day. That was a powerful example to him showing how your surroundings and mental state can affect pain.
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That is pretty cool, Scott. It certainly makes things easier if the patient can give you an example to build off of. It kind of speaks to what Eric has been saying about asking the patient to reflect and throwing in little nuggets (or strips if you prefer) along the way for them to think about.
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This is a great video. I like the step back it takes towards the end to really show the viewer all of the factors that contribute to someone’s pain experience.
I have tried using the analogy that most of us have heard where someone would not feel an ankle sprain if a bus was coming toward them or a lion was near etc. I think most people understand this conceptually, but do not correlate it to their situation(due to it not being individualized). I think using a similar analogy with athletes in the context of their sport has worked better for me. The best example I can think of is a patient that I am seeing who is a Tae Kwon Do athlete. Asking her if her symptoms change when practicing or competing in TKD versus when she is at home or work and then explaining to her how the environment and her perspective change her symptoms. I think this has helped to change some of her views on her pain, however adding a video like this may help to change her pain experience further. I need to begin collecting videos like this. I really would like to get my hands on a copy of the Why Do I Hurt book as well that seems like a good resource.
I was going to post a recent article from the Journal of Spine Surgery as its own post, but this actually seems like an appropriate place to drop it. It shows the importance of pain education in patients that are undergoing spinal surgery over a 3 YEAR follow up. Take a peek below.
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Great Video!
Another one for the list.
Being at a hospital in inner city chicago with a large medicaid population I am learning how to present this. It is so hard and every patient needs a different explanation.
I am learning how to start simple and only adding as they understand. at first I wanted to keep throwing a lot of analogies and explain it all up front and then I would lose people.Just like with the highly irritable patient, less is sometimes more. Start with a little and add as you go.
To me, this video is not at a 5th grade reading level so it may only work for the highly educated patient. Need to keep that in mind as well
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It is so easy to forget that patients do not have the understanding of the hard anatomy/physiology of their injury and their healing process to the degree that a skilled clinician does because it’s something we understand so well and take that understanding for granted. As a first step to effective intervention we need to make it a point to do our best to educate them on this at the level of their understanding and desire to understand (some are of the mindset of “just tell me what i need to do to get better….I don’t care what the reason is—I got this from a pt recently and it was hard to hear but I’d rather hear the truth from a pt than have him waste both his and my time!) It is also VERY much our job to educate patients on the PERCEPTION of his or her pain and how that will directly affect their recovery. It is very valuable to utilize the pain video…great visual for pts but also important to understand that pt understanding and perception of pain and healing translates to improved outcomes and less dollars incurred to the pt and overall healthcare system as stated in the JSS article. Great resources and reminders!
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I love the construction worker’s boot example Scott!
I like to refer people to Lorimer Moseley’s Ted Talk, Why Things Hurt, which is also SO not on the 5th grade level, but I think patients get a lot from it and he is also so entertaining which I think makes patients more receptive to the concepts.
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I agree Myra. Its such a hard concept that its always going to be above that basic level. I think that lorimer is able to keep things simple but complex at the same time
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To help a patient understand central sensitization it can be beneficial to help them understand with a peripheral sensitization analogy. David Butler talked about using sunburn as an analogy.
A sunburn can be a great way to do that, as most people have experienced a severe sunburn at some point in their life. Have them reflect on what it felt like. Ask them what it felt like to get a warm shower or even wear clothing over the affected area. Explain that this is due to sensitized nerve ending in the skin; becoming sensitive to the heat and/or pressure.
You can then ask the patient what it felt like after they were in the shower for awhile (the nervous system settles down and doesn’t hurt as much).
This can help reduce fear of movement. Just as the nervous system settles down while in the shower, it can settle down with continued movement. You aren’t fearful of the pain while in the shower, why are you fearful of the pain when walking, bending, squatting or whatever. And this conversation can only continue from there.
Thoughts on using this analogy?
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Justin, I like this analogy as a means of discussing peripheral sensitization and fear of pain. When you have a sunburn putting clothes near that area is painful, but people are not fearful of increasing damage in that area, and like you said, pain typically decreases after habituation to that stimulus. I like the way you phrased it, “You aren’t fearful of the pain while in the shower, why are you fearful of the pain when walking etc”. I think my metric for a good chronic pain analogy is the complexity and the number of ways it can go south. For example, for this one the patient could talk about how their sunburn continued to hurt with clothes/shower, or they could flip the analogy and compare movement of the painful area to going back out into the sun with a sunburn. I think being able to manage these moments is a very hard skill, and in my experience simpler examples are the best because they allow for less creative interpretation by that patient that may have spent 10+ years with a negative and fearful outlook.
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I like this video as a PT/healthcare provider video instead of patient education possibly. I liked the emphasis on the output of pain altering chemistry as well as muscle/joint/fascial tension as I think this is a good reminder that although the emphasis of our treatment should be on general activity and PNE, some more targeted treatments to those areas should still be pursued. I think as I dig more into this information and treating these patients I have sometimes lost sight of some our other treatments due to a hesitance to rely on passive treatments.
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